Utility of Pramana in Ayurveda – A Review

Ayurveda has inculcated many principles from darshana shastra. Pramana is one such principle which is widely used in Ayurveda with certain modifications in its applicability. With the keen observation and analytical skill the ancient sages identified the pramana as the tool to gain thorough knowledge. Ayurveda has adopted pramana namely aptopadesha, pratyaksha, anumana, yukti along with other types. The word pramana and pariksha are used synonymous in Ayurveda. Systematical analysis and gaining the exact knowledge is pariksha. Vast application of these can be seen in the treatises. Thus a literary review is taken up as an attempt to understand the utility of pramana in Ayurveda with respect to understand the basic concepts, field of research, diagnosis and treatment of disease is done.


INTRODUCTION
Ancient India is the abode of the intellectuals and great thinkers. Their keen observations and analytical skills at gross and subtle level, lead to compose treatises on complex subjects in the absence of sophisticated instruments with accuracy. Ayurveda physicians of the past established the tools of knowledge i.e. pramana which proved to be an excellent tool to gain knowledge then and even now. Thus, the ancient physicians, with their high levels of intelligence, and extra ordinary skills of observation, and interpretation achieved intellectual phenomenon with the help of pramana.

MATERIALS AND METHODS
Literary review from Ayurveda samhita namely Charaka Samhita & Sushruta Samhita.
Aptopadesha are the tarka rahita (doubtless), nischaya (definite), yathartha jnana (absolute knowledge) provided by the aptas[9], also considered as agama i.e, Veda[10] (knowledge). The knowledge that arises of the combined effort and interaction between the artha (object), indriya (sense organ), manas (mind) and atma (soul) at that moment is called as pratyaksha. Anumana is the inferential knowledge based on valid information with previously perceived knowledge (pratyaksha) with the help of yukti and tarka. The inferential knowledge that one arrives after a careful introspection of various cohesive factors is defined as yukti [11]. The knowledge gained by comparing an unknown object with known is called as upamana [12]. The relevant hidden and unexplained meaning through the mentioned reference can be obtained through arthapatthi pramana [13]. If one statement is placed, certain other relevant references are also understood which are the part of the former is considered as sambhava [14]. The knowledge of absence or non existence is obtained through abhava pramana. Cheshta pramana is the tool to elicite through the different expressions, movements and postures.

DISCUSSION
Pratyaksha and anumana are the bifold examination for a scholarly person. For others aptopadesha with the above two constitute the methods of examination; by incorporating all these, conclusion can be drawn through yukti pramana. Ayurveda has inculcated many principles from darshana shastra. Pramana is one such principle which is widely used in Ayurveda with certain modification in its applicability. Ayurveda emphasize on Trividha pramana viz. pratyaksha, anumana and aptopadesha and all others can be subsudated in these three as aitihya pramana under aptopadesha pramana, upamana pramana under pratyaksha and anumana, sambhava, abhava, arthapatti under anumana pramana; abhava pramana under pratyaksha pramana. Several pramana quoted in darshana are considereded in Ayurveda in different context as depicted in (Table 01).

Understanding of the Basic Concepts of Ayurveda and its Application
Ayurveda is an agama shastra in the form of trisutra. Aaptopadesha is the base for all other pramana, it is the authentic source of practical knowledge and application. Loka purusha samya siddhanta, similarity is present in the universe and physical body, based on this the aggravation and depletion of the body contents can be corrected. In punarbhava nirupana it is inferred as the action performed in the previous life called as daiva are unavoidable, eternal and has continuity. Its result corresponds to the action, which is the causative factor for the karmaja vyadhi. Adharma is considered as the root cause for the janapadodhvamsa vyadhi [15]. The understanding of epidemic and pandemic diseases can be attributed to all these pramana. Assessment of Ayu (lifespan) is based on the anguli pramana (anthropometry) [16,17] in svastha (healthy) and arishta lakshana in rogi (diseased) [18] is done through prtyaksha, aptopadesha, yukti. Drushta karma is considered as one of the required qualities of bhishak (physician), knowledge about internal organs is achieved through shavacheda [19] and surgical skills has to be practiced in the experimental models[20]. Before arriving at a conclusion with regard to diagnosis or treatment of a disease, it is essential to contemplate on the teachings of the seers as it helps in gaining the exact knowledge [21]. Aptopadesha pramana guides in identifying the anukta vyadhi through nidana, adhishtana and svabhava of roga. Considering the patient as apta, prashna pariksha identifies the subjective state of health or disease [22]. The diagnosis and estimation of the prognosis is done through pratyaksha pramana eg. haridra varna in kamala, gurghuraka shabda in tamaka shvasa, puti puya gandha in vrana, sheeta, karkasha etc. sparsha in shotha. Anumana pramana helps in diagnosing a disease based on purvarupa, complications and fatal signs and symptoms. Rasanendriya pariksha is attributed through anumana pramana which helps in assessing arishata lakshana in certain diseases by observation of whether the insects like makshika, yuka etc. gets attracted towards the sample of urine, body parts etc [23]. Yukti pramana is a tool for assessment of kriyakala (stages of diseases), fixing time and dose of medicine. Identification of diseases like kushta, visarpa, bhagandara, prameha pidaka are classified based on dosha's are named by giving simile of different fruits or parts of animals, eg. rishyajihwa, ushtragreeva, etc.) Identifying the nature of disease like the swelling in kroshtuka shirsha vyadhi is similar to head of an animal called kroshtuka. In gradhrasi vata the gait will be similar to that of gradhra (vulture). In understanding effectiveness of treatment like eranda taila is compared to kesari in treating the amavata which is like gajendra. Yukti, aptopadesha are the vital aids necessary for arriving at a precise diagnosis and effective treatment strategy.

Understanding the Research Methodology
There are several references of research protocol in classics, like identification of drugs, disease (anukta vyadhi), survey study, clinical research in the form of several formulations to one disease and single formulation for many diseases, animal studies like anna raksha vidhi. Scope for survey and observational studies are highlighted eg., excess use of kshara, lavana, pippali; viruddha ahara etc. thus aptopadesha pramana is useful in selecting the topic and identifying the solution. In the field of research pratyaksha and yukti pramana plays a pivotal role along with anumana pramana which helps in designing the protocol to preparation of the report. Drug, clinical, experimental researches are mainly based on yukti and pratyaksha. Survey studies, analysis of the pharmacodynamics of the drug are based on anumana pramana. Entire research can be explained with parartha anumana using pancha avayava vakya.

Utility of other pramana in Ayurveda with its Clinical Application
Arthapathi pramana can be considered in understanding upashaya (relief) and anupashaya (aggrevation). The formation of upadhatu like stanya and artava from rasa dhatu and assessing the rasa dhatu dushti in the diseases of artava and stanya; manifestation of vyadhi due to nidana sevana can be considered under sambhava pramana. Abhava (non-availability) of certain signs and symptoms helps in differential diagnosis and final diagnosis. Vyadhi mukta lakshana like in jvara, unmada, atisara [24] etc. The ayoga of indriyartha, karma and kala are considered as causative factors for disease. These suggest the utility of abhava pramana. Cheshta is considered as the method to diagnose the disease through expression and actions. It helps in diagnosis of sharirika and manasika vyadhi. eg. bhibhatsa cheshta (involuntary movement) along with the feature of loss of memory and darkness can be observed in apasmara, cardinal feature of sanyasa, arishta lakshana can be understood as in unmada. Activities like frequent touching of painful body parts by the child[25] suggest certain pediatric illness. The ancient concept of evidence is based on fourfold testing, called pramana. However, it must be emphasized that fruitful strategies for developing new scientific evidence cannot succeed if traditional primary evidence is ignored. New research and understanding of the new diseases and its treatment is to be planned on the foundations of existing textual and experience-based evidence.

SIGNIFICANCE OF THE STUDY
The study highlights the efficacy of "PRAMANA" which is an ancient tradition, used in some parts of India. This ancient concept should be carefully evaluated in the light of modern medical science and can be utilized partially if found suitable.

DISCLAIMER
The products used for this research are commonly and predominantly use products in our area of research and country. There is absolutely no conflict of interest between the authors and producers of the products because we do not intend to use these products as an avenue for any litigation but for the advancement of knowledge. Also, the research was not funded by the producing company rather it was funded by personal efforts of the authors.

CONSENT
It is not applicable.

ETHICAL APPROVAL
It is not applicable.